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Episode 110: NICU and Beyond: A Neonatologist's Insights on Supporting Breastfeeding

, , , , June 7, 2023

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Jacqueline Kincer  0:37  

Welcome back to the Breastfeeding Talk Podcast. I’m your host, Jacqueline Kincer. And today’s guest is one that I am very excited to bring to you. I just don’t know, I record these episodes, and I go wow, that’s the best episode yet. And it just keeps happening. And it’s amazing. And I hope that you’re enjoying the episodes as much as I am. In fact, if you are enjoying the episodes, please do me a huge favor, head over to Apple podcasts, you can leave a review that helps our ranking which helps our podcast get discovered by listeners who would love to come across this information and level of support and a podcast. Spotify also allows you to leave a rating. So we would encourage you to do that if you’re a Spotify listener, whatever method works best for you. And then of course, anytime you’re listening to episode, something really resonates with you. If it’s one of our little corner, sort of sound bites that you see us posting over on Instagram or YouTube shorts, or you want to take a screenshot on your phone of you listening to that episode, post that to your stories, tag us share it with a friend, spread the word because chances are if you’ve benefited from something you’ve heard in one of these episodes, there’s someone in your network that will benefit from it as well. 


So I want to introduce Dr. Susan Landers to you. She’s an amazing human and I’m so glad I got to talk to her. I feel like I should do a little like, I don’t know, sort of besides these episodes, because the conversations I have with our guests before and after we hit record are just wonderful. And sometimes I feel like I need to go back and hit the record button. But that’s kind of my little treat as the interviewer that I get to partake in. So Susan Landers is a neonatologist, a pediatrician who has extra training in the care of sick and premature babies, and she attended Auburn University and the Medical University of South Carolina. She completed her pediatric residency training at the University of Texas Southwestern Medical School in Dallas, Texas, and a neonatology fellowship at Baylor College of Medicine and Texas Children’s Hospital in Houston, Texas. Dr. Landers practiced academic neonatology for 14 years on the faculty of two medical schools. After that, she worked for Pediatrics Medical Group and private practice neonatology for 20 years. While caring for patients full time and private practice. She served as a speaker for the Texas Department of State Health Services. She was the Medical Director of the Mother’s Milk Bank at Austin and served on the milk banks board of directors. She was elected as a fellow in the Academy of breastfeeding medicine. 


Additionally, she served on the executive committee of the section on breastfeeding for the AAP, the American Academy of Pediatrics for six years. Together with her husband, Dr. Phillip Berry, she raised three children, one son and two daughters. Now she’s retired and she resides in Austin, Texas. So if that doesn’t give you an idea of the wonderful esteemed Dr. Landers and the incredible expertise that she brings to the table, I don’t know what will but you’re gonna have to hear it from her yourself. And without further ado, I would love for you to get to know Dr. Landers and her wonderful knowledge and perspective on breastfeeding, human milk and the state of New motherhood. Listening. Welcome to the show Dr. Landers. I’m honored to have you here with us today, because you are just a wealth of expertise and very unique in your profession. And I’m super excited for the listeners to hear your version of a brief overview of your background and experience as a neonatologist, your involvement with breastfeeding medicine and all the things so tell us a bit about yourself. 


Dr. Susan Landers  4:19  

Well, first of all, thank you for the invitation. Any person, especially an ibclc, who talks about breastfeeding medicine, is tops in my book. Do not spend enough time supporting breastfeeding mothers in our culture, and I’m so glad you’re doing this with your podcast. I am retired now, but I practiced at the neonatologist for 34 years and I love that specialty. For couple reason. It was fun to work with mothers and babies and see babies get better pretty quickly grow and thrive. And it was also really exciting. Intensive Care Medicine can be stressful, but because we have such good technology, ventilators, surfactant, lines, tubes, breast milk, babies are doing better and better all the time. And so it was a field that I loved working in. When I started in neonatology, we were giving formula to all the babies, we would soup it up, you know, 2428 calories for ALS. And the little guys wouldn’t do very well. They didn’t grow very well, they all got an advertising and our colitis was just abysmal. That was back in the 80s. And the La Leche League had come back into full force. And breastfeeding was back as a trend. And in the late 80s and early 90s, mothers were beginning to express their breast milk and ask us breast milk in the NICU. I nursed my first child briefly a few months, because I went back to work, I didn’t have a good pump. I nursed my second child for six months, because they went back to work and sat around in the NICU moms pumping room talking to other mothers. It was so fun because we all traded secrets and advice. 


And I could tell what was going on with them. And then I would kind of you know, sneak back into the NICU and say I need to talk to her so and so she’s very discouraged. Anyway, as we learn more and more about the use of breast milk in the NICU, and as we started to get breast milk that moms pumped or express to feed their own babies, we began to see that babies did better when they were fed mom’s milk, but they didn’t grow as well. And that was the time and the fortifiers are being developed and they were powder fortifiers before they were liquid fortifiers. It was an exciting time because various units were doing different things and telling mothers different things. We had a suspicion that breast milk fed babies who were sick in the NICU survive more often had fewer infections, and definitely got more necrotizing in our blindness. But until some randomized controlled multicenter trials proved that some nurseries are still not pushing breast milk use for NICU babies. And I’m talking about full term not just preterm babies. Once the trials prove that breast milk fed human milk fed neonates live lift, more often died less often had less necrotizing enterocolitis had less nosocomial infections, then the cow was out of the barn, so to speak, then everybody jumped on the bandwagon and started learning how to support the moms who are crucial to the whole endeavor, because she was the producer of the breast milk. So that brings us to the early 2000s. And I became so interested in how support moms in the NICU. I was at Arkansas Children’s Hospital, Dan and I helped develop a Mother’s Milk Bank and that Children’s Hospital and it was such great experience because that was a state where breastfeeding rates were very low. But if you tell mothers that pumping their milk could save their baby’s life and decrease their baby’s rate of infection. They said, Oh yeah, I want to do that. 


Of course I want to do that. I mean, even if they didn’t want to breastfeed, they were willing to express the milk so we can feed it to the babies that are bred some papers and some other people around the country did some research. And it became obvious that if you started mother’s pumping early after birth, if you did scan the scan, also called kangaroo care. If the mom actually was in the nursery with her baby a lot of the time, you can help mom increase milk supply and get more milk to get into more sick premature babies. And that time was very exciting because we were really learning how to help the moms and using the milk more. Then we discovered how to use fortifiers to make the little guys Bro well enough because human milk is great for babies, but it’s really great for big preemies and full term babies. Premature babies have higher protein needs. Higher mineral needs, higher fat needs, and so they don’t grow well on unfortified mother’s milk. And we were learning all of that we were learning how to fortify the milk properly to get the babies to grow well. And so right at that same time, other experts in the field around the country, were saying, Well, you know, people traditions in general, and even neonatologist, my group don’t know that much about breastfeeding support and don’t know that much about healing milk. And that’s when we develop the Academy of breastfeeding medicine. And they were obstetricians, family practitioners, pediatricians, neonatologists, all came together, and decided to write guidelines for clinical care. And that was about 20 years ago. And that turned out to be a huge success. 


We began to teach pediatricians how to better support breastfeeding, and the moms especially. And so my passion for breastfeeding. And it’s changing from working with the moms also nursing kids myself and sitting there and the puppy working with them, and taking care of babies who did better when they weren’t human milk fed. And I was so fortunate to be able to practice during a time when we were learning about that. I mean, we know all that now, but but we didn’t know that 20 and 30 years ago. So as I look back, that’s one advantage of being older, you get to look back and see what were the big deals. That was a really big deal. I mean, it wasn’t just a ventilator. It wasn’t just artificial surfactant. It wasn’t just how to treat infections, it was give a baby their mother’s breast milk, that made a huge difference and how premature and sick infants did in the NICU, it was just so much fun to be on the cutting edge of that whole movement. And today, people just sort of go, oh, yeah, I’m gonna breastfeed. And they’re, I just think it’s exciting to talk about the history of that, because it really was a little bit of a struggle at the beginning, until we learned what we were doing. I


Jacqueline Kincer  12:42  

yeah, you you really were and are such an important part of that history. And I agree, I think that perspective is really important. You know, one of the questions that comes up whenever we do, like prenatal consultations is, you know, do you know the history of your, your mother, your grandmother or sisters, aunts, anybody in your family with breastfeeding? And a lot of the time, that’s not not a great story. And they’re like, you know, I wish I wish they would have breastfed me. And I’m like, Well, let me remind you that things were different. Your mom was probably told that formula was better than breast milk. Like, there’s a lot that has changed, you know, and to put it in context, I think it’s important, because we have come such a long way. I’m curious, throughout that time that, you know, you started advocating for this increase in breastfeeding support and use of human milk and, and working to support that. Was there resistance that you encountered, either from colleagues, hospitals, the parents themselves? I’m curious how that went, because I can’t imagine it was just, Oh, yeah. Dr. Lander says, This is great, let’s do it. But maybe


Dr. Susan Landers  13:52  

there’s always, there’s always resistance to do something that’s new. It’s harder to support a breastfeeding mom in the NICU. Because you have to get her started pumping early. She has to be there and do some skin to skin, she has to pump six or eight times a day. She needs to understand even before delivery, that her milk is going to make a huge difference in her baby’s outcome. She needs to be motivated, and the staff needs to know that it’s the best thing for the baby. So when I was at Arkansas Tolerance, I had some nurses who said what is the big deal? Why don’t you just use formula? And I would say, well, they actually do better on breast milk. And she said, Somebody else said something like, well, it’s dirty. I don’t want to help them with breastfeeding. And I said that’s a real antiquated attitude. It’s not dirty. It’s the best thing in the world. We’re mammals. We are meant to nurse our guys. And so yes, there were biases and prejudice against it, whether it was from nursing staff or other positions. But as the science came out, and as like Tension consultants were allowed into the NICU to support the moms because NICU nurses could be too busy to support the mom. Things got better. And LCS, made a name for themselves, they could take a mom who had on turn about six or eight times a day, for six weeks, or 28, weaker kids now 34 weeks and help mom put the baby to the breast. And guess what the little darling could actually nurse for three or four minutes and get some milk. And mothers were elated and the nurses were so happy and the LCDs were helpful. And the doctors went, Wow, I never believed this would happen. 


And so it was this whole process of expanding the team, if you will, as the nurses didn’t know as much as the LCSW. And dietitians in some instances, some of the doctors in my group and pediatricians didn’t know how to manage breastfed premature babies. And after delay after discharge, they might just put them on return formula. So there were lots of different attitudes about what was the right thing to do. And it did take a lot of saying, here’s the science. This is what we know, here are the follow up studies here that controlled trials to convince people that it was worth the effort, it is a whole lot easier to feed formula to a sick baby, it is a whole lot better to feed their mother’s milk to a sick baby. It just takes a whole lot more work. Because you’re working with the mom, Mom’s not your patient, but she’s crucial to the well being of your patient. So it actually increases the work a little bit. And I think that’s why some physicians are resistant to it. Now all that is passed. Now everyone knows human milk feedings are best for neonates, one thing I didn’t mention premature babies who are fed their mother’s milk, even if they never breastfeed, if they just get to fed their moms now, they do better on developmental follow up scores and IQ scores at 18 months and two years of age. That is amazing. That means that what protein and amino acids that they’re getting in their body and and developing their brain are so important that they do better, having been fed their mom’s milk. It’s just amazing, even if they didn’t go home breastfeed. And those those studies were done at a lot of big city county hospitals, where moms would pop for, you know, four or five, six weeks, and then kind of give up and the babies would go home. Even if they had had one month of human milk phase, they did better at 18 months and two years of age. I think there’s another cohort that’s going to be examined at three years. And that data should be published pretty soon. So we know that the development is better. Babies just do better if they’re fed or mom’s milk.


Jacqueline Kincer  18:28  

And so important to look at those things and to really talk about this because it’s part of informed consent for one. But that can be such a motivating factor like you talked about, you know, it’s not just the mechanics of pumping the milk and bringing it to the baby. It’s also that there has to be this motivation of the mother to do that. She has to put in a lot of work. So if you know that you’re like, wow, I would love to give my child the biggest advantage possible, especially since they have to be in the NICU. So that’s incredible. And on that note, like you’re saying there’s this huge benefit to the mother’s own milk. Maybe we could shift gears a little bit and talk about donor milk because I think oddly enough, there’s still like a hesitation on the part of some families about that, like, oh, that’s someone else’s milk, which, you know, when you drink cow’s milk else’s cow. Yeah, you don’t know those cows. So you know, just kind of funny, but like, yeah, donor milk is so important because it’s human milk, but yeah, maybe you could talk about that a bit since you did the milk pink and everything as well.


Dr. Susan Landers  19:35  

I would love to sew it. In Arkansas. I did the mother’s own milk back and then when I moved to Austin, Texas, there was a donor milk bank in Austin, Mother’s Milk Bank of Austin, and I was invited to be the medical director there. And I learned about process of pasteurizing donor milk and I learned how the donor moms are sprayed very carefully for hepatitis B, Hep C, HIV, all the STDs, they have to have a drug history, they have to have all the lab work done. They can’t even take ADHD meds and donate milk. So it’s a very, very precise process to select moms who have a lot of milk whose babies are thriving. So they have extra milk, and then they donate it to the milk bank, the milk is pooled, and then it’s pasteurized. And only babies who have a doctor’s prescription to get the Jenner milk, get it. And of course, it’s refrigerated or frozen and shipped frozen on ice. It’s a little expensive donor milk is still very expensive for hospitals to purchase. But there are some reasons that some women can’t breastfeed or can’t produce breast milk. Moms on drugs that are that preclude breastfeeding moms, they’re not very many of those, you know, like lithium, heroin and methadone. All of them regular drugs, antidepressants, and other antibiotics, those are all totally compatible with breastfeeding. Some moms have had previous breast surgery and can’t proceed. 


And so they want an alternative. Because we don’t want them to feel bad if they can’t breastfeed, or they’re taking medicine that excludes them from nursing, they want an alternative. And that alternative is pasteurized donor human milk, when the process is very controlled, and carefully done to make sure the donors are healthy. Now there are 28 milk banks around the country. Now there’s a Human Milk Bank Association of North America. And so all the children’s hospitals and all the NICUs in our country use milk from one of those milk banks. Some of your listeners have probably heard about the sale of donor milk on the Internet and matching donors and recipients on the Internet. And I’m here to stay in correlation with the opinion of the American Academy of Pediatrics. And the Academy of breastfeeding medicine, that process does not say, when you buy or receive milk, donor milk on the internet. Get it from your neighbor, you don’t know about that donor Mother, you don’t know her history of drugs, medication, you don’t know the tests that she’s taken to make sure that she’s clean, so to speak. And so it’s a little risky. For that reason, sometimes the milk is shipped in a condition, it’s not safe, not totally refrigerated or frozen. Sometimes the milk is diluted out with cow’s milk, there have been reports that sometimes the milk is infected and has bacterial overgrowth. Those things don’t happen when the milk comes from a better human milk bank. They only happen when people are trying to make the best of it with their neighbor or on the internet. So we’d caution your listeners against trading breast milk and accepting donor breast milk from a friend or someone you don’t know on the internet. There are some risks. And I think moms need to understand and talk to their pediatrician about it because they don’t want to give their baby something that’s harmful. When they’re what they’re really trying to do is giving them something beneficial.


Jacqueline Kincer  23:54  

That’s such a good point. Yeah, I, I think the number of times I’ve counseled people, and I know it’s come up in an episode before where I’ve said, you know, if you were to properly screen an informal donor, odds are three questions in they don’t want to do that work. And they’re not going to they’re not going to give you they’re not going to go with their labs drawn and give that to like the, if you want to, if you want to safely screen somebody, I just don’t think that person that you’re getting it from is willing to put in that effort, which I don’t blame them because they’re kind of like, why, you know, but someone else is willing to take it without those questions, unfortunately. So it becomes a really tough proposition. Where are you making concessions on safety? Because you just would rather have the milk than not and you know, yeah, it’s unfortunate. So I’m glad you said something about that is


Dr. Susan Landers  24:45  

and I hate to be discouraging to moms have a perfectly healthy neighbor who’s got extra milk, but you just have to be careful because you’re feeding your own baby. Something that you do not totally know whether there are medications or chemicals or herbs or infectious agents in that middle. I mean, there may be a virus or maybe cytomegalovirus in that milk, not just hepatitis or HIV. So be very, very careful with how they get donor milk and to recognize that their pediatricians can help them get milk from a, from a certified accredited donor human milk back.


Jacqueline Kincer  25:30  

Yes, I yeah, I appreciate that. And I think to that, to your point, right like that, realistically, it’s a small minority of moms that are not going to be able to produce enough breast milk. The issue is around, you know, a lot of external factors, the support, the accessibility of things, the affordability of things, to you know, get the right pump to pump enough, you know, all of those things to make it happen. And so if we can support moms, and that, oh, my goodness, what we’ll have a lot better outcomes, I assume.


Dr. Susan Landers  26:07  

That support I think, is 95% of the solution. Mom’s motivation is huge. But she’s set up properly support supported, she’s going to be sort of left in the dust, and then they’ll have a baby ready to nurse and a mom that doesn’t have a supply for her baby. So it’s maternal support is just crucial to make breastfeeding work. Whether it’s a NICU, baby, or full term baby who’s struggling to gain way maternal support is top of the list. The solution? Top of the list?


Jacqueline Kincer  26:44  

Yes. So true. And, and one of the things that I really appreciate that you talk about a lot, like, we’ll link up like your Instagram and social media and whatnot in the show notes, so people can check it out. But that’s kind of what I was like, Wow, this woman is awesome, because you talk about this need for, you know, the care of the mother. And I think that really, is what we’re talking about in terms of, you know, moms providing breast milk, but in general as well, right. And so, you know, especially moms who are working, which is most moms these days, so, you know, you were working mom, yourself, you even said how it was so hard for you, with your first to provide that breast milk. We didn’t have the pomp options we do these days, either. But I’d love for you to talk about that. Because you do have this, you know, kind of personal professional experience with all of that. And you’ve even written a book, kind of on the topic as well. So I just, I think hearing from you, and your expertise about what moms really need, you know, to be supported is really important.


Dr. Susan Landers  27:50  

Yes, thank you for bringing that up. I don’t think that we talked about the fourth trimester, or intressant. Enough. The fourth trimester is that newborn period where mom is learning to care for her baby, learning how to breastfeed properly. And she’s also becoming a mother. And during that time, she is deluged with so many different hormonal changes in her body, that on top of sleep deprivation, that on top of whatever her baby needs, that’s different than the average baby, that on top of how much help she has at home, women in our culture are placed in an untenable situation. If they don’t have help, if they don’t have adequate sleep, if they don’t have the support they need. Breastfeeding can be the most challenging thing that a new mom faces. And if you’re sleep deprived, and you haven’t had more than four or five hours sleep and six weeks, a night in six weeks, you’re going to be in tears if your baby’s crying after you nurse them and not willing to sit and think through what might be going on. And I don’t think Dr. Google has all the answers for new moms. I think new moms need support from experienced health care providers, whether it’s a pediatrician who knows breastfeeding, whether it’s an OB who knows how to recognize postpartum anxiety or depression, whether it’s a great lactation consultant, who knows how to help a new mom, you know, establish a great latch, make sure she feels you can do it or sell. Whether it’s the PT e and t working with that lactation consultant to decide whether or not a baby does have a tongue tie that needs to be read. least all of those things are so crucial. When I went through that with my own daughter, lessor for art, you know, here I am a breastfeeding, and she wanted to nurse her daughter. And it was so painful. She had had depression during her pregnancy and had stopped her antidepressants. Against my advice, I’m not sure whether her psychiatrists recommend that or not, most do not recommend stopping during pregnancy. But anyway, her milk supply was fantastic. But the baby did have a tongue tie. And it hurt her a lot. We went to see a lactation consultant and got some adaptations that helped. But my daughter was so sensitive to pain, that by the time we made it to the pediatric dentist who was going to do the release of a tongue tie, she had decided, I’m just gonna pump and bottle. And I said, That’s fine honey, and she had great milk supply in the baby gateway. And then we’re happy.


But I’ll tell you that experience made her depression worse. And we know that so many mothers who have challenges with breastfeeding, have any breastfeeding difficulty that contributes to their developing postpartum depression. There’s some studies going on to try to tease out what those relationships are. But clearly, women who have difficulties breastfeeding are more likely to have postpartum depression, which is very common one in eight pregnant women have some degree of depression after delivery. And so to get back to the support of the mother, whether it’s the spouse or the partner, or the best friend, or the mother or mother in law that has good breastfeeding experience, we have to help the new mother figure out what’s going on what she can do with her baby, give her the agency she needs to take care of her baby herself. And then she’s going to feel good about nursing or pumping and bottle feeding. I saw that with my own daughter. And it really brought it home to me that if she hadn’t had me there to hold her hand, to take her to the LC to hook her up with a pediatric dentist. She wouldn’t have made it. I mean, it’s just so traumatic to have difficulty and her husband wanted to help but he didn’t know what to do. He didn’t know anything about breastfeeding. So we had good LCSW we had a good pediatrician, we had a good pediatric dentist and everything worked out fine. But it was so traumatic Jacqueline that when she had her second baby. He was a late preterm baby, and he didn’t feed very well. And about 12 hours of age, he had low blood sugar, and she was in tears again, because oh my god, she thought she had done something wrong. Well, he was too sleepy to wake up and nurse and they gave him some donor breast milk. And as what sugar came up, and she tried to nurse and he was kind of lazy, like like preterm babies are kind of weak suck, swallow. And she said, That’s it. I’ve had I’m gonna pump and bottle feed again and I said, Honey, you can nurse this baby he doesn’t have. It’s okay. She said, No, I’m not going to need that again. I know I have good milk supply. I’m just gonna pump a bottle for you. 


That’s it. Okay. And so both of her children received her breast milk for 10 or 11 months, a good amount of time because she went back to nurse to working as a nurse in the pediatric ICU, which is no easy feat. And so her story represents how crucial it is to support new breastfeeding moms. They’re trying to figure out who they are. They’re trying to learn their baby. They’re trying to feed their baby. They’re doing their best to do the right thing. And if they get something said sideways, they get the feelings hurt, they feel guilty. They feel inadequate. We really need to handle new models with kid gloves, because we should recognize that any breastfeeding difficulty puts them at higher risk for trouble. And that the help that they need, generally gets them over the hump and helps them to make it and breastfeed their babies safely. So the answer to your question is As new mothers need all the help and support they can get, not going to visit and hold the baby and offer to feed the baby, but going to visit and doing the laundry and loving the dishwasher, and letting mom take a nap and letting mom nurse her baby and telling her you can do this. Kim looks great. He’s gaining weight. So I think that we do the wrong thing. When we go visit New moms, we put all our attention on the baby. And we want to hold them and you know, get in their face and say how beautiful they are. And what we really need to be doing is supporting the mom. The mom is the one who’s having this massive transformation, becoming a mother learning how to take care of her baby. And that’s what people in the family in France can do to help the support supportive do not interfere with her learning to be a mother.


Jacqueline Kincer  35:59  

Yeah. I mean, I’ve heard of that. Yes. Yes. I mean, how many times you know, I had does that not happen? Right? And, and out of this obligation for keeping familiar relations you, you know, hesitatingly invite your mother in law? Who goes your baby’s crying a lot? Are you sure you making enough milk like that one statement can unravel everything for you, like don’t allow that to happen? And and how this is what I tell parents too, is like, I don’t want this to all be on the mom. Ask your partner to be that advocate for you have them be the screener that’s like excuse me, you cannot say that you cannot come over here and just want to hold the baby. If you come over here, we need you to help with these things. Like you shouldn’t have to be the sole advocate for yourself. So


Dr. Susan Landers  36:47  

Oh, yes, I had to ask by husband to tell my own mother to quit saying Don’t you think he needs a bottle. I mean, I was here was a neonatologist. I was breastfeeding had a good milk supply, nursing Well, a good solid two or three months. And I had to ask her back off. And that’s so common, she had me in tears. And she meant well, she just didn’t know anything about breastfeeding. So your right spouse or partner, or best friend or mother in law, somebody has to say, we need to get this mob a break. We’re not going to say anything that provides guilt or shame, because they’re too fragile. New moms are just too fragile.


Jacqueline Kincer  37:34  

That’s true. And as much as you want to try to be the strong one, right, like a lot of moms do. I think I’m recognizing that is so important. And and you know, to your point about your daughter’s journey, I mean, countless moms that I and my colleagues have worked with that have gone through the same thing with tongue tie, and then subsequent babies and just saying that I’m just gonna pump I don’t want to deal with this, because it’s too much. And there’s, there’s some, you know, trauma that’s happened there. And it’s, it’s really unfortunate. And it sounds like your daughter got I mean, she had you so right. But to your point, like even having you and these other providers that were part of this story, those breastfeeding difficulties still created issues. And so we need to do everything we can, right. Your health care provider, what’s your advice for other health care providers in the community? How can they better support breastfeeding moms and their babies, even especially in the NICU setting, if you want to go there, because without that, like we can do our part, right as families, and somebody can have an amazing family member like you, but we’ve got to have this buy in from everyone else. Pediatricians, OBS midwives, you know, whoever it is,


Dr. Susan Landers  38:51  

yeah. This is such a tender area. You don’t want to say it’s not worth it to breastfeed. Let’s just give one. Although there are some mothers who say, I’m not willing to do this. I would rather formula paid or they’ve had a previous bad experience, and they would rather for me, and those babies are going to do okay, if they’re full term, and if they have good pediatric. But what we want to do is to recognize that what we say to mothers matters, that we want them to know that that they’re capable of doing something that works out. Well. 95% of the time, only about two to 5% of mothers don’t make enough milk to breastfeed and we want to say to those mothers, it’s okay. formula feeding is fine, your baby’s gonna grow up fine. The IQ differences between formula fed babies and breastfed babies are only a few points. It’s not like you’re going to harm your child by formula feeding them. We don’t want to make mothers feel guilty. But we do want to acknowledge that when they choose to breastfeed, they need help and support. Our culture is not a breastfeeding friendly culture. Moms are working 70% of moms or working moms go back to work too early. Or wait six weeks, eight weeks, I never even got to stay at home more than eight weeks with any of my children. Part of that was my own fault. But it’s very common. Do they have a good place to pump at work? Do they have a pump? They can use it work? Is that place clean and safe? Is it private? Is there a refrigeration? Is there a sink? Is there soap and water? The pomp act that was recently passed, is going to make a big difference because it requires employers to provide time and space for mom to express her breast milk when she goes back to work. What about that? A worker who says Well, I didn’t get 15 extra minutes to go home. I mean, so mom’s here, all the stuff from all these different angles, their employer says What do you mean, give me 30 minutes to go pop and store your bill. And the guy next door says wanting to give a special break, even though there’s a law that says mom should get that break. And so mom has to give in herself, she has to defend what she’s doing that she knows it’s the best thing for her baby. Not to mention, she’s left her baby in the care of someone else. Whether it’s at daycare, or with grandparent, or with a friend, she already feels guilty, leaving her new baby when she goes back to work. So we’re heaping so much on top of moms, that I want people to recognize that even after moms go back to work, they’re still fragile, they still and our society lacks support for what they’re trying to do, which is feed their babies the healthiest way they can feed their babies until our culture changes and is supportive of Maternal Infant bonding like that takes more than two weeks off your job, it probably takes four to six months after delivery. 


To really feel like a good mom get to know your baby. I regret only having two months, maternity leaves, I wish I had had four months or more. I was lucky I had a pediatrician for a husband. And he supported everything I did. single moms have a really hard time doing the right thing for their babies and carrying milk back and forth and giving express breast milk to the babysitter to feed their baby. It’s just this propensity for modern American women to work, go back to work, be separate from their babies. And we’re choosing to do that we either have to or we like our jobs. And that places us at higher risk to fail breastfeeding. And that makes us think in our little brain deep inside our brain that we’re not a good enough mom. And that’s not the message we want to be giving to others in our culture. Social media is already getting moms that message. And we don’t want breastfeeding failure when moms go back to work to contribute to that message. That’s one of my biggest beefs with mother modern culture. We are not being supportive of moms after they go back to work. And we’re certainly not supporting moms on social media. We’re making it look like everything is perfect. And everybody’s doing great, but me. So moms are getting the idea that this be stupid or wrong or something because everybody else is perfect, and they’re rested and showered and dressed and their babies beautiful. And here I am struggling. We need women to know that struggling really happens probably what do you think half the time it’s pretty common until you get your feet under you. And unless you have support around you. It takes a while to feel really good about being a mom in our code.


Jacqueline Kincer  44:55  

Just as a quick little aside, what Dr. Landers just mentioned. about things that you need to be aware of in the workplace, but also the new pump act. We actually did a recent episode on our podcast, specifically on the pump act, US breastfeeding laws and the future of breastfeeding healthcare technology with a wonderful attorney, Bethany Corbin. So that is episode 108. So if you’d like more information on this, if you’re working mom, if you’re preparing to go back to work, after you have your baby and continue breastfeeding, check out Episode 108, of breastfeeding talk with Bethany Corbin. And it will give you all of the ins and outs and plus the show notes have some excellent links and resources that Bethany has, thankfully given to us that we’ve added there for you. So you can check that out on our website, holistic To get the full show notes and access the podcast again on any platform like the one you’re listening to. Now, back to the show. Yes, I the only time I haven’t seen someone struggle is when they already had a great degree of social support around them. Lots of family that was involved and close by. It’s not enough to just have a supportive partner at home, it’s not enough to just have another family member come in and help you out. I’ve seen that time and time again. Now. I’m obviously generally working with the people that have problems. So you know, but I, it’s a conversation that you know, you’re out and about, you’re getting your hair cut, you’re at a restaurant, I don’t know what comes up, you know, what do you do for a living? Oh, I’m a lactation consultant. 


And I cannot tell you the number of times I’ve heard sob stories. And I could probably count on one hand the number of times I’ve heard success stories that just breastfeeding just what well from the start. I never understood why people have such a hard time. Like that is the most rare response I’ve ever received. So do people struggle? At least 50% of the time? Yes. What I say, possibly upwards of 75% of the time, possibly. And at some point along the way. Right. And it’s that we don’t want that. You know, and I think what you’re saying is so important, you made a really, really good distinction that I think is so worth saying again, which is that making the choice to breastfeed is not just a choice to breastfeed, it’s a choice to get support in breastfeeding. Like because you will need it. Like something to that effect. You said it much better than I just did. But that’s so key. Because without that, like, I mean, yeah, it becomes something that either breastfeeding happens short term, it happens with difficulty. You know, a number of things may get in the way, right. So, man, I got, I just wish, I wish things were so much better. And hopefully, you know, an episode like this is part of that, right, that we’re working to make this better? And on that note, you know, I guess you’re just such a, what I think is really cool about you, Dr. Landers is that you I think there’s like a stereotype, right of maybe, you know, health care providers in your role or of your age like that you’re not, you know, up to date with everything and you know, but you’re not like that at all. And I love that because we need more people like you sadly retire, but you are still, you know, kind of sharing an important message. So I’d love to hear you know, just what are your are there resources, words of encouragement for, you know, moms listening out there that are facing challenges in their breastfeeding journey?


Dr. Susan Landers  48:33  

Yes, there was an opinion piece in the New England Journal of Medicine, which is one of our premier medical journals, and it was written by a physician who had difficulty establishing her milk supply. I think she had a late preterm baby 35 or 36 weeks. And she said she got help from a lactation consultant. She said she was helped by her husband. She wrote that her pediatrician helped her she was on Triple feeds. You know, you nurse the baby, then you pump your breasts to make the establish a better milk supply and then you bottle feed milk to the baby. And that process would be very labor intensive. We all know that was taking her an hour and a half every two to three hours. And she ultimately failed for a number of reasons. And as I read her story, I thought, Well, did she go to a pediatrician that knew anything about like preterm babies and breastfeeding? Does she have lactation consultant who really understood how to support moms with late preterm babies because they look like they’re full term but they act like little slugs. They’re just sleeping in for feeders and have a week suck, swallow and it just eggs for six weeks to get them with the probe. RAM and you have to maintain a milk supply and wait until they kind of wake up and learn how to nurse. And as I read her story, I thought it’s so sad that even a physician mom, I think she was a failed practitioner, who wasn’t trained in breastfeeding medicine, who tried to get support still fail. 


And she felt so strongly about it that she wrote this opinion piece. And I think what happened is she didn’t get the support she needed, or that she was ambivalent about breastfeeding and having to go back to work, or that she was exhausted, or he might have had a little postpartum depression. What you’re pointing out that all pediatricians are not expert in breastfeeding management is true. I am sorry to say. Some pediatricians were trained how to feed babies with formula. And then breastfeeding came along and got popular and they weren’t training how to support breastfeeding mothers. Why? Honestly, moms are going to need to ask their pediatricians and family practitioners if they have any extra training in breastfeeding medicine, if they’re a member of the Academy, breastfeeding medicine, if they’re a member of the section on breastfeeding of the AAP, those doctors tend to have had extra training in how to support moms how to work with LC aids. OB e’s are joining the Academy of breastfeeding medicine and family practitioners. For the same reason. All physicians do not understand how to support a breastfeeding mom. And our culture makes it harder for moms. And until we have people like you and me being mothers and helping our daughters along that culture will not change. So we’re arguing for specific certification of pediatricians in breastfeeding medicine that’s probably coming in the future. So moms can talk to their pediatrician before delivery. Ask about the pediatricians interest in supporting breastfeeding, aka their OB about it, make sure it’s not just a second thought. Because it’s as important to take classes about breastfeeding as it is to take classes about birthing. I think we can be more supportive in public and breastfeeding moms. I go out of my way, when I see somebody nursing in public, I say oh, good for you. What a good job. Oh, I’m so proud of you. 


And they always smile and they always look at me and I say, keep keep it up, you know, and I used to be one of these people who would breastfeed in public and I didn’t care I wouldn’t. I wouldn’t timid, my husband roll his eyes use a you don’t have to do that. But, but I did it anyway, to make a point. And I think we can, as a culture, stand up for nursing moms, we can recognize that not all healthcare providers have the knowledge and expertise they need to help breastfeeding moms. And we can ask about that and have conversation. We can all also do what you talk about, which is be very careful in the kind of lactation consultant, or the kind of birth expert or birth consultant that we hired to help us not all LCS are ibclc certified train, that’s a clinical expertise and a level of knowledge that is the highest, the gold standard for lactation consultants. And I think that moms need to know who they’re working with. And whether or not the lactation consultant and the pediatrician have the training and have experience to help them not only their family members and other support people, but the health care providers is there’s


Jacqueline Kincer  54:18  

so, so many really great pieces of advice there for everybody because, yeah, there’s, unfortunately, a lot of work that we still have to do ourselves to make sure that we are getting good support and all of that and that’s really, uh, you know, not to like to plug myself I’m not the only one out there doing this, but that’s why, you know, myself a lot of other lactation consultants do so much telemedicine because there may not be somebody with the skill set that you need where you live, unfortunately, and it would be better for you to get that skill set virtually than not have it and so, you know, it’s harder for us to deliver that kind of work, but we want to, you know, provide it It’s an option. So yeah, we will, you know, definitely kind of put in the show notes, what you mentioned about the Academy of breastfeeding medicine and the AAP section on breastfeeding. Those are, some great resources, you know, a bit of a directory there to look some folks up. So


Dr. Susan Landers  55:15  

definitely, yes. Oh, I


Jacqueline Kincer  55:17  

appreciate everything you’ve shared with us, Dr. Landers, where can people find you to continue to expose themselves to your wonderful message and just, you talk a lot about burnout and things of that nature as well, which I love one of my favorite topics. So maybe just give us a little brief overview?


Dr. Susan Landers  55:37  

Oh, yeah, I’m so glad you asked me about that. You know, I love breastfeeding medicine. And I love nursing moms. But I switched over and provided an emphasis in my writing and my support for working moms. Because what I see, as an older retired physician is working moms who are struggling, who are frazzled, who are overworked, who are comparing themselves to others on social media, who have employers, they don’t lie, they’ve all just been through this horrible pandemic. They’re trying to manage their job and their children. And they’re not doing well, quite honestly, working moms are struggling, whether you can breastfeed or not. And so I have chosen to focus on working moms and burnout because I feel so passionate about how difficult it is to do everything we’re doing today. My daughter has two children, now a six-year-old and a two-year-old. And she’s working on her Master’s to become a nurse practitioner. And one Sunday afternoon, the kids are running around, I was kind of watching and not doing much. And somebody had a little say about something. And she looked at me and said, Why is this so hard? And I went Honey, it’s hard. Because it’s hard, you have a full-time job, you’re in school full-time, we’ve had two little children, this is not easy. And so I want working moms to know that it’s not easy to get all this stuff done. And our husbands don’t always help us like they should our partners don’t do 50%. All the surveys show they do way less than us. We have a mental load. That’s way heavier than our partner. We worry about the stalker costume up and uniform, and we worry about the play date. And we’re thinking about the shot that needs to get done next week. And our husband’s wondering whether you can watch the NBA Playoffs. And it’s just like totally different women, working mothers think about all these things, not just their job and their children, but all the things that hold that whole read together. 


And so what I like to talk about is how important it is to take care of yourself as a working mom, to take a break to get out of it. To take a walk around the block, to have coffee with a friend to talk to your spouse after the kids are in bed, and tell them I’m at the end of my rope. I just really need more help, can we hire a maid? I mean, there are so many things that we could get help with. And we don’t pass. Social media doesn’t help us. It just gives us comparisons with folks who look perfect, but they’re not really. And so I want moms to know that when they take a walk around the block, it’s good for their mental health. When they have coffee with a friend and confide in your friend, it’s good for them. When they go out and exercise, walk a couple of miles, it’s good for them. When they get adequate sleep. It’s really good for them. And when they ask their partner for support, specifically say I need you to pick up the kids this Thursday. Because I want to go do this with mine. But that’s okay to do. I want to give working moms the permission to take care of themselves. I had to learn that the hard way. I bet you did, too. We all sort of brave our own way. But as a culture, we’re not very good at saying to other working moms, this is hard. What you’re doing is hard. It is no easy feat to raise a family and have a relationship and how that’s different. And so we need to be kinder to ourselves. Learn how to take care of yourself, and take a break. give ourselves some grace and so That’s what I’m writing about. Hate. Okay.


Jacqueline Kincer  1:00:04  

That’s the best. That’s the best. And to your point, too, I just wanted to say that for any moms who are not working a job outside the home, I often see them thinking that they need to take on so much more than they should by virtue of being a stay-at-home. Mom, you need a break to like it’s not. It’s not a picnic being a stay-at-home, mom. In fact, I’ve been both, and it’s way easier to be a working mom, let me tell you, so just wanted to throw that out there.


Dr. Susan Landers  1:00:32  

Oh, we need to talk more about I had a stay-at-home mom,


Jacqueline Kincer  1:00:35  

when work is a break. You know, it’s hard. Right?


Dr. Susan Landers  1:00:39  

And my stay-at-home mom, sister-in-law, she was the best baseball mom, all four of her kids were into baseball. And I said, JK, you just make this look so easy. And she said That’s not easy. I’m exhausted. I’m always in the car. I’m always going from practice to practice. And I said, Can she do all the stuff at school, all the stuff I wish I could do? And she said, volunteer for that stuff. Because I know that working moms can’t do it. And I said to her sweetie, because we can’t, we really can’t make it to all the stuff. And so it takes all of us, it takes the whole ball of wax the whole village to make it work to raise our kids today. But I do have lots of resources for working moms on my website, Susan Landers If moms go there, there’s a free burnout checklist that they can find and other free resources. You mentioned my book, I wrote a book about the NICU, my favorite NICU babies, and some stories. Of course, all the parents gave me permission. And I also told stories of my own struggles. It’s a working mother. And my book is called so many babies. And people can get that book on Amazon or Barnes and Noble wherever. But I read the book to let other women know that we all struggle, and we all try to do our best. And we just have to learn to be kinder to ourselves and take care of ourselves and each other. So I hope people enjoy the resources on my website, I have a blog or two. So I can’t seem to quit working. That’s just


Jacqueline Kincer  1:02:29  

I was gonna say retire but not retired. Seriously, thank you for putting together those amazing resources. And like I said, we’ll link up your contact information and all of those important links in the show notes. And it’s been an honor to talk about breastfeeding and motherhood and working and all the things with you today Dr. Landers. Thank you for being here. Thank


Dr. Susan Landers  1:02:52  

you so much. I appreciate it. This was fun.

In this episode of Breastfeeding Talk, host Jacqueline Kincer engages in a thought-provoking conversation with guest Dr. Susan Landers, whose impressive background includes working full-time as a neonatologist while serving as a speaker for the Texas Department of State Health Services, Medical Director of the Mothers’ Milk Bank at Austin, a Fellow in the Academy of Breastfeeding Medicine, and also contributing to the Section on Breastfeeding for the AAP for six years.


Together, Jacqueline & Dr. Landers delve into the critical role of breast milk in the NICU and the challenges faced in advocating for its use. They explore the importance of donor milk, the need for informed consent, and the significance of maternal support in making breastfeeding work.


The episode also addresses the struggles of working mothers, the cultural shifts required to create a supportive environment, and the essential role of healthcare providers in empowering breastfeeding mothers. With personal stories and practical advice, this episode sheds light on the journey of breastfeeding mothers, fostering understanding and offering valuable insights for both healthcare professionals and new moms alike.


In this episode, you’ll hear:

  • NICU changes and advancements in the field of breastfeeding medicine over the last 30 years
  • Support mothers in the NICU need to breastfeed & provide milk to their babies
  • The role of fortifiers to promote healthy growth in NICU babies
  • Resistance and challenges faced when advocating for human milk feedings in the NICU, including biases and prejudice against breastfeeding.
  • Addressing the concerns and potential dangers of online donor milk sources.
  • Emphasizing the crucial role of maternal support in making breastfeeding work, with practical tips and advice for new moms during the challenging fourth trimester.
  • Shedding light on the prevalence of postpartum depression and the importance of support systems for new mothers
  • Dr. Landers’ own breastfeeding experiences 30 years ago and her journey supporting her own daughters in breastfeeding
  • Struggles faced by working mothers in balancing breastfeeding and professional responsibilities
  • Needed cultural shifts required to foster a more supportive environment for breastfeeding and the role of healthcare providers, including lactation consultants, in empowering mothers with the necessary knowledge and resources.
  • Burnout among working mothers and the importance of self-care and taking breaks to maintain mental health and sustain breastfeeding journeys.


A glance at this episode:

  • [5:00] Breastmilk in the NICU
  • [13:25] Resistance that Dr. Landers encountered when she started advocating for human milk
  • [19:04] Why donor milk is so important 
  • [26:48] Why maternal support is crucial to making breastfeeding successful
  • [38:04] Dr. Landers’ advice for other healthcare providers to help support their communities
  • [46:53] The importance of support in breastfeeding


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